Anatol J Cardiol 2018; 20: 368-72 Letters to the Editor
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simple palliative procedure. Eur J Cardiothorac Surg 2013; 44: 1096-102. [CrossRef]
2. Piskin S, Unal G, Arnaz A, Sarioglu T, Pekkan K. Tetralogy of Fallot Surgical Repair: Shunt Configurations, Ductus Arteriosus and the Circle of Willis. Cardiovasc Eng Technol 2017; 8: 107-19.
3. Piskin S, Altin HF, Yildiz O, Bakir I, Pekkan K. Hemodynamics of pa-tient-specific aorta-pulmonary shunt configurations. J Biomech 2017: 50: 166-71. [CrossRef]
4. Agematsu K, Okamura T, Takiguchi Y, Yoneyama F, Harada Y. Rapid growth of pulmonary artery after intrapulmonary artery septation. Asian Cardiovasc Thorac Ann 2018; 26: 479-81. [CrossRef]
5. Lashkarinia SS, Piskin S, Bozkaya TA, Salihoglu E, Yerebakan C, Pekkan K. Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation. Ann Biomed Eng 2018; May 14. [Epub ahead of print] [CrossRef]
6. Piskin S, Ündar A, Pekkan K. Computational Modeling of Neonatal Cardiopulmonary Bypass Hemodynamics with Full Circle of Willis Anatomy. Artif Organs 2015; 39: E164-75. [CrossRef]
7. Arnaz A, Pişkin Ş, Oğuz GN, Yalçınbaş Y, Pekkan K, Sarıoğlu T. Ef-fect of modified Blalock-Taussig shunt anastomosis angle and pulmonary artery diameter on pulmonary flow. Anatol J Cardiol 2018; 20: 2-8. [CrossRef]
Address for Correspondence: Dr. Ahmet Arnaz,
Acıbadem Mehmet Ali Aydınlar Üniversitesi Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı,
Halit Ziya Uşaklıgil Caddesi No:1, 34140,
İstanbul-Türkiye Phone: +90 212 414 45 16 Fax: +90 212 414 44 90
E-mail: ahmetarnaz@yahoo.com
©Copyright 2018 by Turkish Society of Cardiology - Available online at www.anatoljcardiol.com
Author`s Reply
To the Editor,
We thank the author for their interest in our studies and re-sults and for bringing up this point. As the author has mentioned, shunt operations are challenging procedures in congenital pa-tients because it is difficult, if not impossible, to predict short- and long-terms performance in specific patients (1-3). Thus, pa-tient-specific surgical planning and decision making for shunt configuration (location, diameter, and type) are crucial for the success of surgery (3-6). In our study (7), we have investigated in detail the performance of shunt configurations in terms of pulmonary flow rates, energy (pressure) loss, and blood dam-age (hemolysis). Moreover, we have studied the effect of pul-monary artery diameter and pulpul-monary vascular resistance on pulmonary flow rates. Tables 2 and 6 present the right, left, and total pulmonary artery perfusion calculations. In the “Flow splits” subsection of the Results section, flow preference has been discussed on the basis of shunt configuration, pulmonary artery diameters, and pulmonary vascular resistance.
In the Discussion section, flow preferences have been dis-cussed on the basis of pulmonary resistance, shunt anastomo-sis angle, and pulmonary artery sizes.
Furthermore, in the Conclusion section, we have suggested that the anastomosis angle between the shunt and pulmonary artery has a crucial effect on flow splits directed to the pulmo-nary arteries. The shunt angle should not be directed toward the narrow pulmonary artery (right or left) since total pulmo-nary flow rates decrease. Furthermore, vertical anastomosis configurations increase total pulmonary perfusion; thus, these configurations are preferable compared with leaned anastomo-sis shunt configurations.
We, hereby, thank again the author for their fruitful discus-sions. They have summarized shunt surgery planning based on previous literature and our current paper. They have also em-phasized the importance of the topic and remarked the place of our current paper among the surgical planning literature.
Ahmet Arnaz, Şenol Pişkin1, 2
Department of Cardiovascular Surgery, Faculty of Medicine, Acıbadem Mehmet Ali Aydınlar University; İstanbul-Turkey
1Department of Mechanical Engineering, Koç University;
İstanbul-Turkey
2Department of Mechanical Engineering, University of Texas at San
Antonio; San Antonio-TX-USA
References
1. Dirks V, Prêtre R, Knirsch W, Valsangiacomo Buechel ER, Seifert B, Schweiger M, et al. Modified Blalock Taussig shunt: a
not-so-Value of ATRIA risk score and gender
in predicting adverse events in patients
with myocardial infarction
To the Editor,
I have read the article by Çetinkal et al. (1) entitled “Com-parative performance of AnTicoagulation and Risk factors In Atrial fibrillation and Global Registry of Acute Coronary Events risk scores in predicting long-term adverse events in patients with acute myocardial infarction” with great interest, which was published in Anatol J Cardiol 2018; 20: 77-84. In their study, the authors divided 1627 patients with acute myocardial infarc-tion into three risk groups according to ATRIA risk score: ATRIA 0, ATRIA 1-2, and ATRIA >3. They reported that ATRIA risk score >3 was found to be an independent predictor of major adverse cardiac events in this group. This is a well-written study, and I would like to draw attention to the gender-related differences that can affect the results of the present study.
